The American College of Surgeons/Association of Program Directors in Surgery National Skills Curriculum: adoption rate, challenges and strategies for effective implementation into surgical residency programs.

Background: The American College of Surgeons/Association of Program Directors in Surgery (ACS/APDS) National Skills Curriculum is a 3-phase program targeting technical and nontechnical skills development. Few data exist regarding the adoption of this curriculum by surgical residencies. This study attempted to determine the rate of uptake and identify implementation enablers/barriers.

Characterization of resident surgeon participation during carotid endarterectomy and impact on perioperative outcomes.

Introduction: The impact of resident surgeon participation during vascular procedures on postoperative outcomes is incompletely understood. We characterized resident physician participation during carotid endarterectomy (CEA) procedures within the 2005-2009 American College of Surgeons National Surgical Quality Improvement Participant Use Datafile and evaluated associations with procedural characteristics and perioperative adverse events.

Methods: CEAs were identified using primary current procedural terminology codes; those performed simultaneously with other major procedures or unknown resident participation status were excluded.

Positive predictive value of the AHRQ Patient Safety Indicator "postoperative wound dehiscence".

Background: The Agency for Healthcare Research and Quality patient safety indicator (PSI) 14, or "postoperative wound dehiscence," is 1 of 4 PSIs recently adopted by the Centers for Medicare & Medicaid Services to compare quality and safety across hospitals. We determined how well it identifies true cases of postoperative wound dehiscence by examining its positive predictive value (PPV).

Study Design: A retrospective cross-sectional study of hospitalization records that met PSI 14 criteria was conducted within the Veterans Health Administration hospitals from fiscal years 2003 to 2007.

Design and development of a surgical skills simulation curriculum.

Background: A number of significant changes have forced surgical educators to re-evaluate the adequacy of traditional forms of surgical skills training.

Materials: A review of the literature reveals that surgical simulation has emerged as a useful adjunct to help educators adjust to the demands of an ever-changing surgical practice environment. As such, integration of simulation technology into a busy surgical training program has now become a priority for training programs worldwide.

Laparoscopic parastomal hernia repair using a nonslit mesh technique.

Background: The management of parastomal hernia is associated with high morbidity and recurrence rates (20-70%). This study investigated a novel laparoscopic approach and evaluated its outcomes.

Methods: A consecutive multi-institutional series of patients undergoing parastomal hernia repair between 2001 and 2005 were analyzed retrospectively.

Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies.

Background: Virtual reality (VR) training has been shown previously to improve intraoperative performance during part of a laparoscopic cholecystectomy. The aim of this study was to assess the effect of proficiency-based VR training on the outcome of the first 10 entire cholecystectomies performed by novices.

Methods: Thirteen laparoscopically inexperienced residents were randomized to either (1) VR training until a predefined expert level of performance was reached, or (2) the control group.

Delayed gastric emptying in patients undergoing antireflux surgery: analysis of a treatment algorithm.

Purpose: Controversy remains about the treatment of patients with mild delayed gastric emptying (90 min < emptying half-time [T(1/2)] < 180 min) who undergo antireflux surgery. This retrospective, nonrandomized study reviewed the records of patients treated from January 1996 through October 2003, during which time we applied two treatment algorithms for patients with mild delayed gastric emptying. The goal of this study was to determine whether the most recent treatment algorithm was effective in reducing the need for a concomitant gastric drainage procedure, pyloroplasty.

A comparison between fluoroscopically guided radiofrequency energy delivery and conventional technique in an animal model of fundoplication failure.

Background: The use of radiofrequency energy (RFe) treatment at the gastroesophageal junction (GEJ) has been considered an alternative to surgery after fundoplication disruption. It is unknown whether the recommended delivery technique for primary gastroesophageal reflux disease applies to an anatomically altered GEJ following fundoplication. The aim of this study was to determine whether modifications to the standard technique using fluoroscopic guidance more accurately localizes ablation zones compared with standard technique alone.

Radiofrequency energy delivery to the lower esophageal sphincter (Stretta procedure) in patients with recurrent reflux after antireflux surgery: can surgery be avoided?

Background: Recurrent reflux following antireflux surgery (ARS) can be difficult to manage, especially in patients who also fail medical management. In these patients, redo ARS remains the only treatment option. Endoscopic radiofrequency energy delivery to the lower esophageal sphincter (the Stretta procedure; Stretta, Curon, Sunnyvale, CA) has been shown to significantly decreased symptom scores and improve quality of life in patients with gastroesophageal reflux disease (GERD).

Attempted establishment of proficiency levels for laparoscopic performance on a national scale using simulation: the results from the 2004 SAGES Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) learning center study.

Background: The Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) has been well validated as a training device for laparoscopic skills. It has been demonstrated that training to a level of proficiency on the simulator significantly improves operating room performance of laparoscopic cholecystectomy. The purpose of this project was to obtain a national standard of proficiency using the MIST-VR based on the performance of experienced laparoscopic surgeons.

Groin hernia: anatomical and surgical history.

The history of surgical repair of groin hernia is a lengthy record of assorted techniques in search of a cure for an ailment that comes in many sizes and shapes and that has plagued humanity for thousands of years. Although improvements are still being sought and found, for several decades surgeons have had the means to relieve most hernia sufferers. A remaining issue is whether the wide array of surgical procedures can or should be whittled down to a few "standard" operations that are safe, effective, and cost-efficient.

Perceptual, visuospatial, and psychomotor abilities correlate with duration of training required on a virtual-reality flexible endoscopy simulator.

Background: Trainees acquire endoscopic skills at different rates. Fundamental abilities testing could predict the amount of training required to reach a performance goal on a virtual-reality simulator.

Methods: Eleven medical students were tested for fundamental abilities.

Evaluation of a tensiometer to provide objective feedback in knot-tying performance.

Training and assessment methods for knot tying by medical students or residents have traditionally been subjective. Objective methods for evaluating creation of a tied knot should include assessing the strength and quality of the knotted suture. The purpose of this study was to evaluate the use of a tensiometer as a feedback device for improving knot-tying performance.

Real-time objective assessment of knot quality with a portable tensiometer is superior to execution time for assessment of laparoscopic knot-tying performance.

Objective: Laparoscopic intracorporeal knot tying is a difficult skill to acquire. Currently, time to complete a knot is the most commonly used metric to assess the acquisition of this skill; however, without a measure of knot quality, time is a poor indicator of skills mastery. Others have shown that knot quality can be accurately assessed with a tensiometer, but obtaining this type of assessment has typically been cumbersome.

A prospective trial on initiation factor 4E (eIF4E) overexpression and cancer recurrence in node-positive breast cancer.

Objective: A previous study of patients with stage I to III breast cancer showed that those patients whose tumors were in the highest tertile of eIF4E overexpression experienced a higher risk for recurrence. This study was designed to determine whether high eIF4E overexpression predicts cancer recurrence independent of nodal status by specifically targeting patients with node-positive disease.

Methods: The prospective trial was designed to accrue 168 patients with node-positive breast cancer to detect a 2.

Construct validation of the ProMIS simulator using a novel laparoscopic suturing task.

Background: The use of simulation for minimally invasive surgery (MIS) skills training has many advantages over current traditional methods. One advantage of simulation is that it enables an objective assessment of technical performance. The purpose of this study was to determine whether the ProMIS augmented reality simulator could objectively distinguish between levels of performance skills on a complex laparoscopic suturing task.

Relationship between tissue ingrowth and mesh contraction.

Contraction is a well-documented phenomenon occurring within two months of mesh implantation. Its etiology is unknown, but it is suggested to occur as a result of inadequate tissue ingrowth into the mesh and has been associated with hernia recurrence. In continuation of our previous studies, we compared tissue ingrowth characteristics of large patches of polyester (PE) and heavyweight polypropylene (PP) and their effect on mesh contraction.

When fundoplication fails: redo?

Objective: The largest series in the literature dealing with redo fundoplication was presented and published in 1999 and included 100 patients. Herein we update this initial series of 100, with 207 additional patients who have undergone redo fundoplication (n = 307).

Summary Background Data: Increasing numbers of patients are failing esophagogastric fundoplication and requiring redo procedures.

Correlation between perceptual, visuo-spatial, and psychomotor aptitude to duration of training required to reach performance goals on the MIST-VR surgical simulator.

Given the dynamic nature of modern surgical education, determining factors that may improve the efficiency of laparoscopic training is warranted. The objective of this study was to analyze whether perceptual, visuo-spatial, or psychomotor aptitude are related to the amount of training required to reach specific performance-based goals on a virtual reality surgical simulator. Sixteen MS4 medical students participated in an elective skills course intended to train laparoscopic skills.

Video-assisted surgery represents more than a loss of three-dimensional vision.

Background: Loss of depth cues is a major challenge facing surgeons performing video-assisted surgery (VAS). Whether the degradation of image quality from a video-displayed image plays a direct role in performance of VAS has not been studied.

Methods: Twenty-four volunteer novice subjects were randomized to binocular direct-vision (BDV), monocular direct-vision (MDV), or video-imaging (VI) conditions.

The history of anatomy and surgery of the preperitoneal space.

Preperitoneal (properitoneal) space is the space between the peritoneum and transversalis fascia. Bogros (1786-1825) described a triangular space in the iliac region between the iliac fascia, transversalis fascia, and parietal peritoneum. In the modern concept, this space lies between the peritoneum and posterior lamina of the transversalis fascia.

Laparoscopic approach reduces likelihood of perioperative complications in patients undergoing adrenalectomy.

Laparoscopy has been reported advantageous over the conventional open technique for adrenalectomy. However, most comparative series include the relatively more challenging cases in the open group. The aim of this study is to assess the actual role of laparoscopy in reducing perioperative complications compared to open surgery in patients undergoing adrenalectomy.

The effects of gastric surgery on systemic ghrelin levels in the morbidly obese.

Hypothesis: Circulating ghrelin, produced primarily in the stomach, is a powerful orexigen. Ghrelin levels are elevated in states of hunger, but rapidly decline postprandially. Early alterations in ghrelin levels in morbidly obese patients undergoing weight reduction surgery may be attributed to gastric partitioning.

TLK1B is elevated with eIF4E overexpression in breast cancer.

Introduction: The overexpression of eukaryotic initiation factor 4E (eIF4E), a critical component of the "RNA helicase" necessary for the initiation of protein synthesis of mRNAs with long 5' prime untranslated regions (5'UTRs), can result in malignant transformation. In a prospective study on breast cancer outcome of women with stage I to III disease, eIF4E overexpression was an independent predictor of cancer recurrence (RR = 7.3, CI = 1.

Objective psychomotor skills assessment of experienced and novice flexible endoscopists with a virtual reality simulator.

The objective of this study was to determine whether the GI Mentor II virtual reality simulator can distinguish the psychomotor skills of intermediately experienced endoscopists from those of novices, and do so with a high level of consistency and reliability. A total of five intermediate and nine novice endoscopists were evaluated using the EndoBubble abstract psychomotor task. Each subject performed three repetitions of the task.